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New Hampshire rates for HCPCS 50389

Removal of nephrostomy tube, requiring fluoroscopic guidance (eg, with concurrent indwelling ureteral stent)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $1,819.70 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $181.97 / $489.78
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $25.12 / $25.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,412.54 / $2,630.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $134.90 / $776.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $398.11 / $1,202.26
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,943.28 / $7,943.28 / $7,943.28
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $436.52 / $1,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,943.28 / $7,943.28 / $7,943.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $436.52 / $1,000.00